Anatomy of an Epidemic: Magic Bullets, Psychiatric
Drugs, and the Astonishing Rise of Mental Illness in America, by
Robert Whitaker (2010)

This provocative book asserts that the
explosion in mental illness in the United States over the last few
decades is largely due to the use of psychoactive medications claimed
to treat mental diseases. Prior to the advent of these
psychopharmaceuticals, conditions such as severe depression, bipolar
disorder, and even schizophrenia typically responded well to rest and
psychotherapy. Most patients were discharged from mental institutions
after 3-12 months and returned to their prior social function.
Recurrences could occur, and their mental condition could restrict
social and employment options, but most returned to their families and
their work. However, in tandem with the growing use of
psychopharmaceuticals, the number of people diagnosed with mental
disorders has skyrocketed, the readmission rate to mental institutions
is far higher than in former times, and a much greater fraction of
people with mental disorders are socially incapacitated by their
disease and unable to resume gainful employment. Whitaker asks, if
these drugs are so effective, why are so many more people sick?

The answer, Whitaker argues, is that the drugs are turning acute,
self-limited conditions into chronic diseases. He acknowledges that
psychopharmaceutics probably can help manage some patients’
psychiatric disorders, but they should be used with far more caution
than is today’s standard. These drugs alter brain physiology, because
the brain adapts to drugs that enhance or inhibit various
neurotransmitters. This can cause dependence on drugs, induce new
psychiatric disorders, or result in long-term worsening of the
original condition. Many patients end up on a cocktail of medications,
each aiming to curb new symptoms that appear to be side-effects of
other medications. Many of these medications tend to dull feelings and
thinking, much to the dismay of patients. Further, many psychotropic
medications have severe medical side-effects, including obesity and
diabetes. As one might expect, psychiatrists rarely acknowledge that
they might have induced mental diseases in their patients – they
generally assert that those who have become sicker while on the drugs
have had other underlying conditions “unmasked” by the drugs, but in
general there is no evidence that this is indeed the case.

In
fact, Whitaker notes that, despite extensive efforts to identify the
“chemical imbalances” that psychiatrists and their friends in the
pharmaceutical industry routinely claim are responsible for
psychiatric illnesses, such imbalances have never been found. While
psychotropic medications might alleviate the symptoms of mental
disorders (for example, by sedating a person suffering from mania),
they don’t necessarily address the underlying diseases. Using backward
reasoning, psychiatrists conclude that, if medications that change
brain chemistry seem to make people better, then the problem must be
with the brain chemistry. But, as one reviewer noted, this is like
saying that chronic pain conditions are due to a deficiency of
opiates, since narcotics activate opiate receptors in the brain. While
the chemical imbalance theory of psychiatric disease is dubious,
researchers have been able to document chemical imbalances that emerge
when people are put on psychotropic medications.

Do these
medications really make people better? People in studies randomized to
those given a sugar pill and those given a psychotropic medication
(which is the standard for FDA approval) quickly recognize which one
they are getting by the non-psychiatric side-effects that many of
these drugs induce. So, those who experience side-effects know they
are getting active drugs, and they might experience a placebo effect.
To test this hypothesis, there have been multiple studies that have
compared psychotropic drugs to other drugs that have side-effects but
no known psychiatric effect (i.e., “active placebo”). Particularly for
the treatment of depression, these studies consistently show little if
any benefit from the psychotropic medication over active placebo. Many
of these medications have sedative, tranquilizing, or other effects
that, in typical industry-sponsored short-term drug trials of 6 or 8
weeks, reduce symptoms such as psychosis. However, there are far fewer
long-term studies, and those that have been done indicate that
patients generally do much better if they have not received
medications.

Whitaker’s tone is sometimes polemical, and he
reserves his harshest words for the widespread treatment of children
with attention deficit hyperactivity disorder (ADHD) and bipolar
disease (a condition that was once virtually nonexistent in teenagers
before the advent of psychopharmaceuticals). Now, Whitaker estimates,
about 3.5 million American children are on stimulants such as Ritalin,
and children as young as two years old are being diagnosed as bipolar.
Whitaker shows that there is compelling scientific evidence that the
explosion of bipolar disease among children is largely due to the use
of drugs to treat ADHD and depression. Further, rapid cycling between
depression and mania, sometimes even in the same day, is a new
phenomenon that, evidently, is a byproduct of brains destabilized by
psychotropic medications.

Why are children put on drugs? Busy
parents and over-worked teachers with too many students find it far
easier to medicate children who have difficulty sitting still than to
disciple them. And, with modern-day prohibitions on restraint and
physical punishment, chemical restraint with drugs might often seem
like the only way to handle children who have trouble sitting still
for hours on end or are otherwise problematic. Proponents of drug use
note that many children diagnosed with ADHD often do better in
classroom tasks if they take the stimulant Ritalin. However, the
children’s ability to perform simple classroom tasks comes at a price,
because there is strong evidence that the drug dulls the mind and
inhibits creativity and critical thinking. Once on these
brain-altering drugs, many children with ADHD treated with Ritalin
need additional medications for “unmasked” bipolar disease or other
conditions, and many if not most of these kids face a lifetime of drug
use. I wonder what my life would have been like if my elementary
school teachers had responded to my misbehaving in class – which was
probably related to boredom – by insisting that I take medications.

The book is replete with anecdotes that put human faces on the
massive numbers of children and adults now crippled by what appears to
be iatrogenic (physician-induced) psychiatric disease. One of the more
heartbreaking stories is a normal, healthy, active girl who, prior to
going into 5th grade, was prescribed an antidepressant to address her
occasional bedwetting prior to her going to going to camp. It induced
homicidal thoughts, for which she was put her on a cocktail of
psychotropic medications. She became obese, and in the 11th grade,
feeling that her doctor was taking her complaints about side-effects
seriously, she abruptly stopped taking Zyprexa. She experienced
withdrawal psychosis leading to a crippled mental status from which
she has not recovered.

Why don’t ethical psychiatrists speak
out? In general, psychiatrists make more money seeing patients briefly
and prescribing drugs than by engaging in “talking therapy.” Further,
the “chemical imbalance” theory is professionally convenient for
psychiatrists, because only they with their MDs can prescribe
psychopharmaceuticals, while non-psychiatric providers such as
psychologists and social workers can only do various kinds of
psychotherapy. The financial conflicts of interest are far greater for
academic leaders (known by the drug industry as “thought leaders”),
whose opinions carry considerable weight with their colleagues,
journalists, and the general public. Nearly all these people receive
large payments from pharmaceutical companies as consultants and
speakers, and often their research labs are lavishly supported by
unrestricted grants from their friends in industry. They are rarely
told what to say, but they know who butters their bread. In addition,
the American Psychiatric Association and patient advocacy groups such
as National Alliance on Mental Illness, receive generous support from
the pharmaceutical industry.

Meanwhile, Whitaker shows, those
academicians who have raised questions or concerns about
pharmacological treatment of psychiatric disorders have suffered
severe professional penalty, which means that those who survive in
academia either endorse the biological model of psychiatric disease
and its pharmaceutical management or keep their reservations to
themselves. Critics from outside academia are dismissed as academic
lightweights, and the drug industry and its allies in academia are
fond of attributing most concerns to the anti-psychiatry Church of
Scientology, which is widely regarded as cultish and repressive.

Whitaker readily acknowledges that many of the studies challenging the
widespread use of psychopharmaceuticals have had significant
limitations. The biggest problem is that it is hard to have good
control groups of medicated versus nonmedicated patients. For example,
studies that compared people with depression who received medications
to those who declined medications might not be valid, because those
who declined might have personal or social resources that made them
more resilient to depression’s effects.

Many more people are
diagnosed with mental disease today in part because, arguably for the
benefit of mental health professionals, the range of mental
“disorders” has expanded greatly. For example, the FDA approved Paxil
for use in “social anxiety disorder” (i.e., shyness), which promoters
of Paxil claim afflicts 13% of Americans. Similarly, the explosion of
people on disability for mental disorders could reflect, at least in
part, the facts that disability payments exceed welfare payments and
that claims of psychiatric diseases are difficult to disprove. And, a
claim of disability is far more likely to succeed if one is taking
psychotropic medications.

There are inherent difficulties of
drawing scientific conclusions from historical data, in contrast to
the scientific “gold standard” of randomized, prospective, controlled
trials. Importantly, Whitaker details several recent prospective
studies that have provided strong evidence that most patients admitted
to psychiatric facilities fare better when they receive various forms
of psychotherapy than when they receive drugs.

Unless I’m
mistaken, Whitaker overlooked what seems to me an important factor
contributing to the preference of drugs for long-term hospitalization
and psychotherapy. When there is government-sponsored health care, as
in many European countries, the long-term costs of one or a few
extended hospitalization and psychotherapy can be less than the costs
of repeated hospitalizations over a lifetime, lifetime use of
expensive drugs, and lifetime enrollment on disability. In contrast,
people are rarely on a given insurance plan for a long duration, so
insurance companies favor treatments that are less expensive in the
short term. Consequently, their plans typically offer only short-term
hospitalization, very limited hours of psychotherapy, and use of drugs
that reduce the symptoms but do not necessarily address the sources of
psychiatric disease.

Overall, Whitaker makes a compelling case
that overuse of psychopharmaceuticals has harmed many children and
adults. I suspect that few readers of his book will connect the dots
and recognize how harm from psychopharmaceuticals relates to animal
abuse. First, I think it shows that humans are just as vulnerable as
nonhumans to abuse at the hands of those with power and authority.
Second, there are good reasons not to trust researchers, academicians,
and health care professionals who have financial conflicts of
interests. We should be very skeptical of those with conflicts of
interest who say that vivisection is necessary, that animal-based
foods are wholesome and nutritious, and that people with mental
disorders need drugs. Third, since researchers can defend virtually
any conclusion by choosing the “right” animal model and the “right”
experimental protocol, vivisection plays an important role in the
profitable campaign to increase the use of drugs.